Our hospital operator communicates obstetric emergencies (OBSTAT) using overhead announcements and text pages. An OBSTAT assembles obstetricians, anesthesiologists, nurses, and technicians. In the event of cardiac or respiratory arrest, our obstetric code blue mobilizes everyone from the OBSTAT team, plus an adult code blue team, neonatologists, pharmacists, and resources for potential perimortem cesarean delivery. The observation that anesthesiologists and obstetricians had more defined roles than nurses during simulated maternal cardiac arrests led to the development of nursing crisis roles (Table 5). Communication to assign and perform these roles is taught in our Obstetric Life Support (OBLS) curriculum and practiced during OBSIM. The preassigned roles represent a major change in practice for nursing staff and continue to evolve on the basis of staff feedback.
Communication with patients and families on the labor and delivery unit is challenging, especially during and after emergencies. Providers at our institution have expressed satisfaction with our disclosure and difficult conversations curriculum created in collaboration with the risk management group. The curriculum outlines the importance of: (1) being empathetic and saying I’m sorry without blame, (2) being objective and avoiding speculation during conversations and documentation, (3) using provider resources including risk management and peer support, and (4) maintaining open lines of communication among providers and with patients.
Communication to and from anesthesiologists is critical for maximizing safety on the labor and delivery unit. Anesthesiologists can add their unique perspective and skill set by actively participating during multidisciplinary rounds, daily workflow, complex patient planning, obstetric emergencies, and communication with patients and families.
Obstetric patients expect and deserve maximal safety, regardless of production pressure and ever-increasing regulatory requirements. With a legacy of patient safety efforts, anesthesiologists are uniquely suited to help foster a culture of safety on the labor and delivery unit. With a multidisciplinary author perspective that includes anesthesiologists, this article summarized the available evidence and local experience of conducting simulation drills and optimizing communication to improve obstetric safety.
Labor and delivery units are heterogeneous, and even the most comprehensive safety strategies may not be applicable or practical for every unit. Therefore, these broad strategies and operational details must be adapted for the individual needs and resources of each unit.
Simulation and communication interventions are difficult to objectively research in the complex environment of the labor and delivery unit. In addition, parallel safety initiatives make it difficult to determine causation between patient safety efforts and outcomes. We are not perfect, but our labor and delivery unit has seen improvements in provider satisfaction, legal liability, and local culture of safety that coincide with implementation of multidisciplinary in situ simulation and communication strategies. Ideally, other labor and delivery units will find our experience useful and continue to build more comprehensive and measurable strategies for obstetric safety.
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